Terry Badger, PhD, PMHCNS-BC, FAAN Professor and Director, Community & Systems Health Science

1. Who Benefits from a Counseling vs. Education Intervention to Improve Psychological Quality of Life in Prostate Cancer Survivors? Terry Badger, PhD, PMHCNS-BC, FAAN Professor and Director, Community & Systems Health Science tbadger@nursing.arizona.edu

2. Acknowledgements Thank you to NCI for funding R21CA113409 Research Team and Co-Authors: Chris Segrin, PhD Aurelio J. Figueredo, PhD Joanne Harrington, PhD, ANP-BC, AOCNP Kate Sheppard, PhD, RN, ANP-BC Stacey Passalacqua, PhD Alice Pasvogel, PhD, RN Maria Bishop, MD, FACP

3. Purpose • Examine what selected factors specified in the stress process model might moderate the response to different interventions designed to improve psychological QOL • Depression, positive and negative affect, perceived stress

4. Stress Process Model

5. Interventions • Telephone Interpersonal Counseling Intervention (TIP-C) • Based on interpersonal psychotherapy • Address mood and affect management, emotional expression, interpersonal communication & relationships, social support, cancer information and resources • Telephone Health Education Intervention (THE) • Based on adult learning principles • Normal prostate health and cancer, treatment, side effects, side effect management, nutrition and physical activity, resources Both were about 30 minutes x 8 weeks

6. Sample • 71 survivors randomly assigned to 1 of 2 interventions • Typical Survivor • Late 60’s (M=66.99), white, married, retired and college educated • Other illnesses than cancer (M=1.82, SD=1.5) • Medications (M=4.64, SD=3.7)

7. Analyses • Individual growth curve parameters for each dependent variable were tested in a series of moderated regression analyses • Intervention condition was the IV • Moderator variables • Age, Education, Social support from friends, prostate specific functioning, cancer knowledge, symptom distress and management • Psychological QOL variables were the DV

8. Interaction of Age x Intervention on CES-D Slopes Telephone Interpersonal Counseling=TIP-C Telephone Health Education=THE

9. Interaction of Social Support from Friends x Intervention on Positive Affect Slopes Men with lowest levels of social support benefitted more in THE Telephone Interpersonal Counseling=TIP-C Telephone Health Education=THE Men with highest levels of social support benefitted more from TIP-C

12. Summary of Differential Intervention Effectiveness on Psychological QOL Outcomes by Survivor Characteristics THE > TIP-C • Depression • Older Age, Lower Social Support from Friends, Lower Prostate Specific Functioning, Active Chemotherapy, and Lower Cancer Knowledge • Negative Affect • Higher Symptom Distress and Lower Ability to Manage Symptoms • Perceived Stress • Lower Education TIP-C > THE • Positive Affect • Higher Education, Higher Social Support from Friends, Higher Prostate Specific Functioning, and Higher Cancer Knowledge

13. Conclusions • Findings support interventions works to improve psychological QOL but • Select carefully who might benefit from which intervention • Health education was clearly beneficial among older men with less education, knowledge, social support, reduced prostate functioning, increased symptom distress and lower symptom management

14. Conclusions Men as survivors were more interested in receiving health information –many unmet informational needs Health education can be routinely available to men and can reduce psychological distress-may act as prevention as well as treatment Augment with counseling if needed

15. Directions For Future Research • Additional research is needed to refine the profiles of who might benefit from different interventions • The goal is simple, rapid, and accurate triage • Explore differential effectiveness in more diverse populations • Examine other potential interventions for men with prostate cancer might improve QOL